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March 31, 2021Article

Novel Score for Stratifying Risk of Critical Care Needs in Intracerebral Hemorrhage Patients: Critical Care Needs in ICH

View ORCID ProfileRoland Faigle, Bridget J. Chen, Rachel Krieger, Elisabeth B. Marsh, Ayham Alkhachroum, Wei Xiong, Victor C. Urrutia, Rebecca F. Gottesman
First published March 31, 2021, DOI: https://doi.org/10.1212/WNL.0000000000011927
Roland Faigle
1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore MD, USA.
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  • ORCID record for Roland Faigle
Bridget J. Chen
1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore MD, USA.
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Rachel Krieger
1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore MD, USA.
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Elisabeth B. Marsh
1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore MD, USA.
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Ayham Alkhachroum
2Department of Neurology, University of Miami, Miller School of Medicine, Jackson Memorial Health System, Miami FL, USA.
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Wei Xiong
3Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland OH, USA.
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Victor C. Urrutia
1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore MD, USA.
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Rebecca F. Gottesman
1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore MD, USA.
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Citation
Novel Score for Stratifying Risk of Critical Care Needs in Intracerebral Hemorrhage Patients: Critical Care Needs in ICH
Roland Faigle, Bridget J. Chen, Rachel Krieger, Elisabeth B. Marsh, Ayham Alkhachroum, Wei Xiong, Victor C. Urrutia, Rebecca F. Gottesman
Neurology Mar 2021, 10.1212/WNL.0000000000011927; DOI: 10.1212/WNL.0000000000011927

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Abstract

Objective: To develop a risk prediction score identifying intracerebral hemorrhage (ICH) patients at low risk for critical care.

Methods: We retrospectively analyzed data of 451 ICH patients between 2010-2018. The sample was randomly divided in a development and a validation cohort. Logistic regression was used to develop a risk score by weighting independent predictors of ICU needs based on strength of association. The risk score was tested in the validation cohort, and externally validated in a dataset from another institution.

Results: The rate of ICU interventions was 80.3%. Systolic blood pressure (SBP), Glasgow Coma Scale (GCS), intraventricular hemorrhage (IVH), and ICH volume were independent predictors of critical care, resulting in the following point assignments for the INtensive care TRiaging IN Spontaneous IntraCerebral hemorrhage (INTRINSIC) score: SBP 160-190 mm Hg (1 point), SBP >190 mm Hg (3 points); GCS 8-13 (1 point), GCS <8 (3 points); ICH volume 16-40 cm3 (1 point), ICH volume >40 cm3 (2 points); and presence of IVH (1 point), with values ranging between 0-9. Among patients with a score of 0 and no ICU needs during their emergency department stay, 93.6% remained without critical care needs. In an external validation cohort of ICH patients, the INTRINSIC score achieved an AUC of 0.823 (95% CI 0.782-0.863). A score <2 predicted absence of critical care needs with 48.5% sensitivity and 88.5% specificity, and a score <3 predicted absence of critical care needs with 61.7% sensitivity and 83.0% specificity.

Conclusion: The INTRINSIC score identifies ICH patients at low risk for critical care interventions.

Classification of Evidence: This study provides Class II evidence that the INTRINSIC score identifies ICH patients at low risk for critical care interventions.

  • Received August 15, 2020.
  • Accepted in final form February 19, 2021.
  • © 2021 American Academy of Neurology

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